Dr. Leopoldo E. Delucca, M.D., F.A.C.S., was the specialist on call. The quiet, young Puerto Rican-born physician was a graduate of Jefferson Medical College in Philadelphia. He had completed his internship at Bryn Mawr Hospital and completed his residency at Thomas Jefferson University Hospital in Philadelphia. He had been a Facial Plastic/Reconstructive Surgeon; Otolaryngologist (Eye, Ears, Nose, and Throat Specialist); and Head and Neck surgeon at Trinity Regional Medical Center since 1981.
The nurse had been unusually agitated when she informed him of the young male patient in the emergency room with the severe nosebleed and dangerously-high blood pressure. In fact, she commented that she had never seen a blood pressure reading so high. Still, Delucca was surprised to see such a robust-looking young man lying on the examining table when he entered the examing room.
Kirk had already lost a significant amount of blood and, after removing the gauze from Kirk’s nose to examine him, Delucca observed that the bleeding was still prominent. He quickly diagnosed the problem as a posterior nosebleed caused by a ruptured blood vessel in the patient’s head.
Most nosebleeds are anterior – occurring in the septum – and are easily contained. Posterior nosebleeds, however – those caused by internal factors – are much more serious and usually found in older patients with vascular disease. Certainly not in a 20-year-old athlete with no previous history!
Delucca was aware, too, that posterior nosebleeds have a greater mortality rate than open heart surgery.
For all of his stalwart physical appearance, Kirk was in hypertensive crisis and literally fighting for his life. His blood pressure was an almost unheard of 240/140. He had suffered horrendous bleeding from the nose and mouth, and his skin was pale and clammy. His eyes showed the fear of uncertainty.
Delucca knew he had to act quickly. He repacked the gauze to stem the bleeding and ordered x-rays to determine if there was a tumor or other obstruction.
Kirk was transferred to a wheelchair and pushed to the x-ray room where extensive pictures were taken of his head. He was feeling a little better – or so he thought – and the bleeding had somewhat subsided.
But, as he sat up from the x-ray table, he felt the blood about to erupt again. He jumped from the x-ray table without waiting for the wheelchair and ran through the hallway back to the examining room where he could lie down on the examining table again. His nose was repacked with fresh gauze while he waited anxiously for the results of the x-rays.
Delucca returned shortly with the x-rays.
“We have a serious problem,” he said calmly but emphatically. “There is no evidence of a tumor, but there is massive internal hemorrhaging, and you are going to have to stay here for a while. Your blood pressure is dangerously high, but we have to stop the bleeding first. If this doesn’t work….” His voice trailed off.
With that he removed the gauze from Kirk’s nose.
“This is going to be one of the most painful things you have ever experienced,” he said, “but it’s our best chance to stop the bleeding.”
Kirk braced himself as Delucca reached for a bladder catheter – a long tube with a “bubble” on the end – and inserted it directly into Kirk’s right nostril and into the nasal passage above his palate.
Mark watched the side of Kirk’s nose bulge grotesquely when the catheter was inserted and turned away, sickened.
Already nauseous from swallowing so much blood, Kirk gagged and began throwing up when the catheter reached his throat. His eyes filled with tears, and he gripped the nurse’s arm with all his might as he vomited blood into the bedpan that she thrust under his mouth. The pain was almost unbearable!
Delucca began pumping water through a hose and into the catheter. As the “bubble” at the end of the catheter inflated with fluid, it would exert pressure on the ruptured blood vessel and, hopefully, stop the bleeding.
For almost ten minutes Delucca waited for the pressure of the bubble to take effect and for the bleeding to stop. But, still, it did not stop.
“It isn’t working,” said Delucca finally. “We’re going to have to take you into surgery to stop the bleeding. I will call your parents while the nurse gets you ready. Don’t worry,” he said reassuringly.
To be continued….